Provider Demographics
NPI:1982606513
Name:MARCELIN, GARDY D (MD)
Entity Type:Individual
Prefix:DR
First Name:GARDY
Middle Name:D
Last Name:MARCELIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 W BOYNTON BEACH BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4540
Mailing Address - Country:US
Mailing Address - Phone:561-734-1212
Mailing Address - Fax:561-734-1443
Practice Address - Street 1:3717 W BOYNTON BEACH BLVD STE 5
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4540
Practice Address - Country:US
Practice Address - Phone:561-734-1212
Practice Address - Fax:561-734-1443
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76514207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002560200Medicaid
C54592Medicare UPIN